Here are some common discharge options across hospitals from most intensive therapy to least. Acute rehab A rehab setting delivering short term aggressive therapy with the goal of the patient returning home afterward. The patient needs to be able to tolerate 3 hours of therapy a day, 5 days a week for about 2 weeks. The patient needs to be motivated, have enough stamina to participate, and have a potential to improve rapidly.
As you gain more experience in the hospital, you will find your own style and methods of performing evaluations and treatments. Here is a sample that can be revised and tweaked as you gain experience: Introduce yourself at the start of the session and give a brief explanation of your role in the hospital. Perform the interview to find out the prior level of function and home environmental setup. Try to talk directly to the patient, not the caregiver.
Before you work with a patient, chart review the vitals range set by the doctor in the patient’s managed orders. The appropriate vitals range will vary from patient to patient. For example, stroke patients may be given permissive hypertension ranges whereas aortic aneurysm repairs may have a lower systolic BP limit. Eventually, you will begin to learn which diagnoses typically have special vitals parameters. Vital parameters may also be written in the physician notes and not updated yet in the managed orders, so it is important to contact the medical team if the orders are not consistent with the doctors notes.
*Every hospital has different practices, so check in with your supervisors and coworkers on how your location triages. There are some principles that generally apply across the board. The primary thought process is that you want to prioritize patients to make the hospital more efficient with discharges and admits. Discharge Pending Patients The most important patient to visit first thing is the one that is ready to discharge but is just waiting for therapy to see them.
(If you’re using EPIC for documentation, the kardex will give you an idea of what lines patients have before you walk into their room.) In line management, a few principles apply: Most critical lines on top, lines oriented towards the side you’re moving to. It also helps if nursing can disconnect any lines before your therapy session. Common lines for medication administration IV line PICC line Central line AV fistula (for dialysis) Note about lines on the patient’s arms: There are some considerations you should take before taking BP readings:
Here are some important steps to chart reviewing. 1.) Check to see that there are active OT orders from the doctor before seeing the patient. 2.) Why is the patient here and what did the doctors do or what are they doing to address it? Sometimes doctors are still working up a diagnosis or the patient has not yet received their procedure. It is preferable to see the patient after they’ve been treated.
When I was trying to break into acute care, I remember having the impression that knowing lab values was the most significant difference between working in a SNF vs a hospital, which was an oversimplification of the truth. While lab values are important in acute care, most therapists don’t memorize these lab values. Most hospital charting programs will actually flag abnormal values for you. Over time, what does happen is the therapist will start to recognize what lab values are important to check for what diagnoses and he/she will start to remember the lower or upper limits naturally.
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